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  5. DAVID M. ADELMAN D D S P A

DAVID M. ADELMAN D D S P A

Company Details

Entity Name: DAVID M. ADELMAN D D S P A
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Inactive
Date Filed: 28 Mar 1969 (56 years ago)
Document Number: 600911
FEI/EIN Number 591237519
Address: 16680 N E 10TH AVE, NORTH MIAMI BEACH, FL, 33162
Mail Address: 16680 N E 10TH AVE, NORTH MIAMI BEACH, FL, 33162
ZIP code: 33162
County: Miami-Dade
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1013361013 2016-04-16 2016-04-16 16680 NE 10TH AVE, NORTH MIAMI BEACH, FL, 331623708, US 16680 NE 10TH AVE, NORTH MIAMI BEACH, FL, 331623708, US

Contacts
Phone +1 305-944-6669
Fax 3059446660

Authorized person
Name DR. DAVID MICHAEL ADELMAN
Role PRESIDENT OWNER
Phone 3059446669

Taxonomy
Taxonomy Code 261QD0000X - Dental Clinic/Center
License Number DN3881
State FL
Is Primary Yes

Other Provider Identifiers
Issuer NPI
Number 1215053160
Issuer MEDICAID
Number 073417900
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
DAVID M. ADELMAN, D.D.S.,P.A. DEFINED BENEFIT PENSION RESTATED 2018 591237519 2019-08-23 DAVID M. ADELMAN, D.D.S., P.A. 1
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1976-04-01
Business code 621111
Sponsor’s telephone number 3059446669
Plan sponsor’s mailing address 16680 NE 10TH AVENUE, MIAMI, FL, 33162
Plan sponsor’s address 16680 NE 10TH AVENUE, MIAMI, FL, 33162

Number of participants as of the end of the plan year
Active participants 1
Retired or separated participants receiving benefits 0
Number of participants with account balances as of the end of the plan year 1
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2019-08-23
Name of individual signing JOEL MARKS
Valid signature Filed with authorized/valid electronic signature
DAVID M. ADELMAN, D.D.S.,P.A. DEFINED BENEFIT PENSION RESTATED 2017 591237519 2018-10-06 DAVID M. ADELMAN, D.D.S., P.A. 1
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1976-04-01
Business code 621111
Sponsor’s telephone number 3059446669
Plan sponsor’s mailing address 16680 NE 10TH AVENUE, MIAMI, FL, 33162
Plan sponsor’s address 16680 NE 10TH AVENUE, MIAMI, FL, 33162

Number of participants as of the end of the plan year
Active participants 1
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Number of participants with account balances as of the end of the plan year 1
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2018-10-06
Name of individual signing JOEL MARKS
Valid signature Filed with authorized/valid electronic signature
DAVID M. ADELMAN, D.D.S.,P.A. DEFINED BENEFIT PENSION RESTATED 2016 591237519 2018-10-05 DAVID M. ADELMAN, D.D.S., P.A. 2
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1976-04-01
Business code 621111
Sponsor’s telephone number 3059446669
Plan sponsor’s mailing address 16680 NE 10TH AVENUE, MIAMI, FL, 33162
Plan sponsor’s address 16680 NE 10TH AVENUE, MIAMI, FL, 33162

Number of participants as of the end of the plan year
Active participants 2
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 2
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2018-10-05
Name of individual signing JOEL MARKS
Valid signature Filed with authorized/valid electronic signature
DAVID M. ADELMAN, D.D.S.,P.A. DEFINED BENEFIT PENSION RESTATED 2015 591237519 2018-10-05 DAVID M. ADELMAN, D.D.S., P.A. 3
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1976-04-01
Business code 621111
Sponsor’s telephone number 3059446669
Plan sponsor’s mailing address 16680 NE 10TH AVENUE, MIAMI, FL, 33162
Plan sponsor’s address 16680 NE 10TH AVENUE, MIAMI, FL, 33162

Number of participants as of the end of the plan year
Retired or separated participants receiving benefits 3
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 3
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2018-10-05
Name of individual signing JOEL MARKS
Valid signature Filed with authorized/valid electronic signature
DAVID M. ADELMAN, D.D.S.,P.A. DEFINED BENEFIT PENSION RESTATED 2015 591237519 2018-10-05 DAVID M. ADELMAN, D.D.S., P.A. 3
Three-digit plan number (PN) 002
Effective date of plan 1976-04-01
Business code 621111
Sponsor’s telephone number 3059446669
Plan sponsor’s mailing address 16680 NE 10TH AVENUE, MIAMI, FL, 33162
Plan sponsor’s address 16680 NE 10TH AVENUE, MIAMI, FL, 33162

Number of participants as of the end of the plan year
Retired or separated participants receiving benefits 3
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 3
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Employer/plan sponsor
Date 2018-10-05
Name of individual signing JOEL MARKS
Valid signature Filed with authorized/valid electronic signature
DAVID M. ADELMAN, D.D.S.,P.A. DEFINED BENEFIT PENSION RESTATED 2015 591237519 2017-10-19 DAVID M. ADELMAN, D.D.S., P.A. 3
Three-digit plan number (PN) 002
Effective date of plan 1976-04-01
Business code 621111
Sponsor’s telephone number 3059446669
Plan sponsor’s mailing address 16680 NE 10TH AVENUE, MIAMI, FL, 33162
Plan sponsor’s address 16680 NE 10TH AVENUE, MIAMI, FL, 33162

Number of participants as of the end of the plan year
Retired or separated participants receiving benefits 3
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 3
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2017-10-19
Name of individual signing JOEL MARKS
Valid signature Filed with authorized/valid electronic signature
DAVID M. ADELMAN, D.D.S.,P.A. DEFINED BENEFIT PENSION RESTATED 2014 591237519 2015-10-07 DAVID M. ADELMAN, D.D.S., P.A. 3
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1976-04-01
Business code 621111
Sponsor’s telephone number 3059446669
Plan sponsor’s mailing address 16680 NE 10TH AVENUE, MIAMI, FL, 33162
Plan sponsor’s address 16680 NE 10TH AVENUE, MIAMI, FL, 33162

Number of participants as of the end of the plan year
Active participants 3
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 3
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2015-10-07
Name of individual signing JOEL MARKS
Valid signature Filed with authorized/valid electronic signature
DAVID M. ADELMAN, D.D.S.,P.A. DEFINED BENEFIT PENSION RESTATED 2013 591237519 2014-10-15 DAVID M. ADELMAN, D.D.S., P.A. 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1976-04-01
Business code 621111
Sponsor’s telephone number 3059446669
Plan sponsor’s mailing address 16680 NE 10TH AVENUE, MIAMI, FL, 33162
Plan sponsor’s address 16680 NE 10TH AVENUE, MIAMI, FL, 33162

Number of participants as of the end of the plan year
Active participants 4
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 4
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2014-10-14
Name of individual signing JOEL MARKS
Valid signature Filed with authorized/valid electronic signature
DAVID M. ADELMAN, D.D.S.,P.A. DEFINED BENEFIT PENSION RESTATED 2012 591237519 2013-10-15 DAVID M. ADELMAN, D.D.S., P.A. 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1976-04-01
Business code 621111
Sponsor’s telephone number 3059446669
Plan sponsor’s mailing address 16680 NE 10TH AVENUE, MIAMI, FL, 33162
Plan sponsor’s address 16680 NE 10TH AVENUE, MIAMI, FL, 33162

Number of participants as of the end of the plan year
Active participants 4
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 4
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2013-10-15
Name of individual signing JOEL MARKS
Valid signature Filed with authorized/valid electronic signature
DAVID M. ADELMAN, D.D.S.,P.A. DEFINED BENEFIT PENSION RESTATED 2011 591237519 2012-09-06 DAVID M. ADELMAN, D.D.S., P.A. 2
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1976-04-01
Business code 621111
Sponsor’s telephone number 3059446669
Plan sponsor’s mailing address 16680 NE 10TH AVENUE, MIAMI, FL, 33162
Plan sponsor’s address 16680 NE 10TH AVENUE, MIAMI, FL, 33162

Plan administrator’s name and address
Administrator’s EIN 591237519
Plan administrator’s name DAVID M. ADELMAN, D.D.S., P.A.
Plan administrator’s address 16680 NE 10TH AVENUE, MIAMI, FL, 33162
Administrator’s telephone number 3059446669

Number of participants as of the end of the plan year
Active participants 4
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 4
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2012-09-06
Name of individual signing JOEL MARKS
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
ADELMAN , DAVID M, DDS Agent 16680 N. E. 10TH AVE, NO MIAMI BEACH, FL, 33162

Director

Name Role Address
ADELMAN DAVID MDDS Director 16680 NE 10 AVE., NO MIAMI BEACH, FL, 33162

Treasurer

Name Role Address
ADELMAN GAIL L Treasurer 16680 NE 10TH AVE, N. MIAMI BEACH, FL, 33162

Secretary

Name Role Address
ADELMAN GAIL L Secretary 16680 NE 10TH AVE, N MIAMI BEACH, FL

President

Name Role Address
ADELMAN DAVID MDDS President 16680 NE 10 AVE., NO MIAMI BEACH, FL, 33162

Events

Event Type Filed Date Value Description
ADMIN DISSOLUTION FOR ANNUAL REPORT 2016-09-23 No data No data
REINSTATEMENT 2014-02-21 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2013-09-27 No data No data

Related by officers

ADELMAN GAIL L

TERI-JO REALTY, INC.

Related by address

No related companies by address

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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